Jugular Venous Doppler Ultrasound as a Non-Invasive Window to Right Heart Hemodynamics: A Narrative Review and Future Perspective.

The Venous Excess Ultrasound Score (VExUS) has produced great interest in venous Doppler ultrasound as a noninvasive means to evaluate right heart hemodynamics. While this score includes Doppler morphologies from sub-diaphragmatic veins, the physiology of transcutaneous venous Doppler velocimetry and its change with cardiac pathology was first studied and described in the internal jugular vein (IJV). Over 50 years ago, the systolic and diastolic velocity waves of the IJV were found to describe the x'- and y-descents of the jugular venous pulse (JVP) in sickness and in health. Therefore, it is established that abnormalities in right heart filling and function are reflected in the jugular venous flow velocity (JVFV) profile. In this narrative review, we highlight the physiology of the JVP, its relationship to right heart performance, and, accordingly, its connection with JVFV. Grounded upon decades-old, pioneering investigations, we briefly highlight JVFV in patients with post-cardiopulmonary bypass physiology, atrial fibrillation, pericardial tamponade, and pulmonary hypertension. We then describe a novel, wireless, and wearable Doppler ultrasound that continuously displays JVFV and consider how this device informs diagnosis and therapy of acute circulatory dysfunction. We touch on gaps in knowledge and suggest future avenues of inquiry with special attention paid to synchronous acquisition and interpretation of venous and arterial Doppler measures. We emphasize the clinical relevance of this technology and physiological framework, including acute, inpatient shock resuscitation, volume removal (eg, "de-resuscitation"), and the possibility for chronic, outpatient monitoring.